Optimising assessments with echocardiography

• Echocardiography is a key diagnostic tool for:²
• Confirming the diagnosis and severity of AS
• Assessing valve calcification, left-ventricle (LV) function and wall thickness
• Detecting other valve disease or aortic pathology
• Providing prognostic information
• Current international recommendations for the echocardiographic evaluation of patients with AS rely upon measurement of mean pressure gradient (the most robust parameter), peak transvalvular velocity (Vmax) and valve area²
• Both the EACVI and ESC/EACTS VHD guidelines recommend a stepwise approach to assessing AS severity using echocardiography:^2,5

^* High flow may be reversible in patients with anaemia, hyperthyroidism or arterio-venous fistulae, and may also be present in patients with hypertrophic obstructive cardiomyopathy. Upper limit of normal flow using pulsed Doppler echocardiography: cardiac index 4.1 L/min/m² in men and women, stroke volume index (SVi) 54 mL/m² in men, 51 mL/m² in women)
^† Consider also: typical symptoms (with no other explanation), LV hypertrophy (in the absence of coexistent hypertension) or reduced LV longitudinal function (with no other cause).
^‡ DSE flow reserve= >20% increase in stroke volume in response to low-dose dobutamine.
^§ Pseudo-severe aortic stenosis= AVA >1.0 cm² with increased flow.
^¶ Thresholds for severe aortic stenosis assessed by means of CT measurement of aortic valve calcification (Agatston units): men >3000, women >1600= highly likely; men >2000, women >1200= likely; men <1600, women <800= unlikely.